Addressing threats to health care's core values, especially those stemming from concentration and abuse of power. Advocating for accountability, integrity, transparency, honesty and ethics in leadership and governance of health care.

Monday, July 23, 2007

Clinical IT mayhem is good for [the IT] business

Clinicians are being asked to become entirely dependent on clinical IT in performing their roles, and the data from the clinical IT will undoubtedly be used to alter clinical power structures, reimbursement, and liability.

Blind faith in the IT and business "experts" is a sure path to hell.

Here's an example of the issues clinicians face from the providers and implementors of this technology - mostly non-clinicians. This collage of issues comes from the former head of the UK's Connecting for Health national clinical IT program, Richard Granger. See article below:

"Sometimes we put in stuff that I'm just ashamed of ... Some of the stuff that Cerner has put in recently is appalling ... Cerner and prime contractor Fujitsu had not listened to end users ... Failed marriages and co-dependency with subcontractors ... A string of problems ranging from missing appointment records, to inability to report on wait times ... Almost a dozen cancelled go-live dates ... Stupid or evil people ... Stockholm syndrome -identifying with suppliers' interests rather than your own ... A little coterie of people out there who are "alleged experts" who were dismissed for reasons of non-performance."

It is quite literally amazing how a national program to implement health IT, that has spent billions of dollars to date, is plagued by the same problems I observed and wrote about almost a decade ago. Every one of the above issues, and more, are found even in organizational-level clinical IT projects.

One wonders if anyone will learn from these issues.

I tend to doubt it. The motto of this industry may well be "Clinical IT mayhem is good for [the IT] business."

This is unfortunate. I am a strong advocate of clinical IT, but as I have written on many occasions, clinical computing and business computing (management information systems) are different subspecialties of computing, and clinical IT will significantly benefit healthcare quality, efficiency and costs, but only if done well.

In getting clinical IT 'done well", it's not about "process" and "six sigma" and "business process re-engineering." There simply is no substitute for brains, integrity (conflict of interest and integrity being polar opposites), proper expertise, and significantly less arrogance from the IT industry about how virtual clinical tools should be developed and deployed.

The departing head of the NHS IT programme Richard Granger has said he is ashamed of the quality of some of the systems put into the NHS by Connecting for Health suppliers, singling Cerner out for criticism.

Going further than he before in acknowledging the extent of failings of systems provided to some parts of the NHS - such as Milton Keynes – the Connecting for Health boss, said "Sometimes we put in stuff that I'm just ashamed of. Some of the stuff that Cerner has put in recently is appalling."

He said a key reason for the failings of systems provided was that Cerner and prime contractor Fujitsu had not listened to end users. "It really isn't usable because they have building a system with Fujitsu without listening to what end users want. They have taken some account but they then had to take a lot more. Now they are being held to account because that's my job."

The latest remarks, quoted in an interview in the current issue of CIO magazine , appear to make a nonsense of Granger's June statement that unless agreement was reached between Computer Sciences Corporation and iSoft over its acquisition by IBA Health, Cerner could wind up as the system used across the whole of the English NHS.

In December 2005 Nuffield Orthopaedic Centre became the first NHS site to go live with Cerner Millennium under the NHS IT programme. It has since suffered a string of problems ranging from missing appointment records, to inability to report on wait times. The Millennium system – now installed at six NHS locations in the South – remains unable to directly integrate with Choose and Book or meet 18-week reporting requirements.

In April, 79 members of staff from Milton Keynes NHS Trust signed a letter outlining their frustrations at the Millennium system, stating: "In our opinion the system should not be installed in any further hospitals.

CfH said there had been some "unacceptable problems" with the new system installed at Milton Keynes. The hospital trust was subsequently visited by Granger and NHS chief executive David Nicholson to learn of the problems first hand.

At the end of June, David Wrede, a senior consultant at Taunton and Somerset Hospital NHS Trust, exasperated by almost a dozen cancelled go-live dates, gave vent to his frustrations with the version of the Millennium system on offer from Fujitsu the local service provider in the South.

Speaking at the BMA's annual representative meeting on 29 June Wrede said: "We should have a public inquiry. The people who made the original Cerner contract should be brought to book and as Cerner Millennium R0 [release zero] is not fit for purpose…" The motion calling for a public enquiry was passed.

The first Cerner installation by BT, the NPfIT contractor in London, is scheduled to go live at Barnet and Chase Farm NHS Trust within the next week. The trust is understood to be due to recieve the same release zero version of the Millennium software that has so far been used in the South. Later sites in London will use London-specific versions of the software.

Granger also cast further light on Accenture's departure from the NPfIT programme at the end of 2006, describing their relationship with sub-contractor iSoft as a failed marriage, in which they had failed to realise their co-dependency. He contrasted the relationship with iSoft with Accenture's performance on Picture Archiving and Communication Systems with Agfa as its sub-contractor. "When they work with a mature, high quality vendor that recognises Accenture as in charge and they're doing it their way, you get a quite good deal and they'll do the job."

The CfH boss goes on to state that he has been careful to avoid Stockholm syndrome -identifying with suppliers' interests rather than those of the NHS - as problems have mounted.

"One supplier asked for an extra £500m to deal with cost overruns. He received a succinct refusal but there are many places where the response would have been different; where threats of bad publicity and contract disputes would persuade an organisation to start bunging millions of pounds a month in addition to the existing contract, just to cover up," says Granger.

Elsewhere in the in-depth valedictory interview carried out ahead of Granger announcing his resignation, he rounds on critics and erstwhile colleagues, saying. "Either people are really stupid or evil. It's difficult to be compassionate with people who claim that suppliers are going out of business because they are not getting paid or they were withdrawing from wishing to do business with the NHS. At the same time, they are saying they [the suppliers] have been bunged millions of pounds that weren't budgeted for. It's stupid or wicked."

He reserves particular ire for so-called experts. "There is a little coterie of people out there who are alleged experts and who worked on this programme. They were dismissed for reasons of non-performance or in one case, for breach of commercial confidentiality.

"He actually sent our financial model to a supplier and that's why we suspended him. He then resigned which is an answer in itself."

Granger continued: "Who contributed evidence to the public accounts committees? For just about every figure quoted as an expert in this programme, I've got HR files on them. They generate a piece of opinion that often substantiates their world view."

1 comment:

Anonymous
said...

This is not limited to the UK. Recently a data tape containing social security numbers, bank account numbers and other personal data was stolen from a state intern's car. Several issues arose. Why was there a delay in reporting the theft? Why was there no way of determining what was on the tape? Why would you physically remove this information from a secured location?

The ultimate issue is: Why are vendors supervising state employees? The vendors set the specifications, time frames, and functionality of a system that controls all of the pay checks for all state employees. This is not the first time this has happened, nor is this the first system to fail.

With a cost plus contract and compliant IT people, the vendors had no oversight, and had no reason to deliver a workable product. The initial estimate is it will cost $7M to provide ID theft protection to all of those possibly at risk. Needless to say the popular press is having a field day with this issue.

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